title: Perineural invasion in aggressive skin carcinomas of the head and neck. Potentially dangerous but frequently overlooked.
abstract: BACKGROUND
  Perineural invasion is a well-recognized form of cancer dissemination. However, it has been reported only in few papers concerning cutaneous carcinomas (basal cell, BCC, and squamous cell, SCC). Moreover, the incidence is considered to be very low. Niazi and Lambert [Br J Plast Surg 1993;46:156-157] reported only 0.18% of perineural invasion among 3,355 BCCs. It is associated with high-risk subtypes, as morphea-like, as well as with an increased risk of local recurrence. No paper was found in the literature looking for perineural invasion in very aggressive skin cancers with skull base extension, with immunohistochemical analysis.
  
  
  METHODS
  This is a retrospective review, including 35 very advanced skin carcinomas with skull base invasion (24 BCCs and 11 SCCs, operated on at a single institution from 1982 to 2000). Representative slides were immunohistochemically evaluated with antiprotein S-100, in order to enhance nerve fibers and to detect perineural invasion. The results were compared to 34 controls with tumors with a good outcome, treated in the same time frame at the same Institution.
  
  
  RESULTS
  Twelve (50.0%) of the BCCs with skull base invasion had proven perineural invasion, as opposed to only 1 (4.6%) of the controls, and this difference was statistically significant (p < 0.001). Regarding SCCs, 7 aggressive tumors (63.6%) showed perineural invasion compared to only 1 (10.0%) of the controls, but this difference did not reach significance (p = 0.08), due to the small number of cases.
  
  
  CONCLUSIONS
  In this series, it was demonstrated that immunohistochemically detected perineural invasion was very prevalent in advanced skin carcinomas. In addition, it was statistically associated with extremely aggressive BCCs with skull base invasion.
authors.affiliation: Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil. cerneamd@uol.com.br
authors.forename: Claudio R
authors.initials: CR
authors.lastname: Cernea
authors.forename: Alberto R
authors.initials: AR
authors.lastname: Ferraz
authors.forename: Inês V
authors.initials: IV
authors.lastname: de Castro
authors.forename: Miriam N
authors.initials: MN
authors.lastname: Sotto
authors.forename: Angela F
authors.initials: AF
authors.lastname: Logullo
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Bacchi
authors.forename: Caio
authors.initials: C
authors.lastname: Plopper
authors.forename: Felipe
authors.initials: F
authors.lastname: Wanderlei
authors.forename: Dorival
authors.initials: D
authors.lastname: de Carlucci
authors.forename: Flávio C
authors.initials: FC
authors.lastname: Hojaij
mesh_terms: D002280:Basal Cell Carcinoma / Q000473:pathology*; D002294:Carcinoma, Squamous Cell / Q000473:pathology*; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D009361:Neoplasm Invasiveness; D009412:Nerve Fibers / Q000378:metabolism / Q000473:pathology; D012189:Retrospective Studies; D009418:S100 Proteins / Q000378:metabolism; D012720:Severity of Illness Index; D012878:Skin Neoplasms / Q000473:pathology*; D019291:Skull Base / Q000294:innervation* / Q000473:pathology*
chemical_list: D009418:S100 Proteins